Survival Outcomes of Ovarian-Sparing Surgery for Early-Stage Adult Granulosa Cell Tumor.

BACKGROUND

Evidence regarding the oncologic safety of ovarian-preserving surgery for the management of early-stage adult granulosa cell tumors remains limited and inconsistent.

OBJECTIVE

To examine overall survival among premenopausal patients with early-stage adult granulosa cell tumors undergoing ovarian-sparing surgery (cystectomy or unilateral salpingo-oophorectomy), in comparison to bilateral salpingo-oophorectomy.

STUDY

DESIGN

This retrospective cohort study utilized the National Cancer Database to identify female patients aged 18-49 years with histologically confirmed stage IA or IC adult granulosa cell tumors diagnosed between 2004 and 2021. Patients were categorized by surgical approach: ovarian cystectomy, unilateral salpingo-oophorectomy or bilateral salpingo-oophorectomy. Propensity score-based inverse probability of treatment weighting was used to account for differences in baseline patient characteristics across the surgical groups. Two- and five-year overall survival was estimated based on Kaplan-Meier methods after applying inverse probability of treatment weighting. The association between surgical group and survival was estimated using Cox proportional hazards regression with inverse probability of treatment weighting and adjustment for treatment factors (hysterectomy, lymphadenectomy, and chemotherapy).

RESULTS

Of 851 patients identified, 76 (8.9%) underwent cystectomy, 445 (52.3%) underwent unilateral salpingo-oophorectomy and 330 (38.8%) underwent bilateral salpingo-oophorectomy. Concurrent hysterectomy was performed in 82.7% of the bilateral salpingo-oophorectomy group, compared with 22.9% of the unilateral salpingo-oophorectomy group. Younger patients (aged 18-39) more frequently underwent ovarian-sparing procedures, while those aged 40-49 more frequently underwent bilateral salpingo-oophorectomy (P < .001). Median follow-up was 77.5 months (interquartile range: 39.2-135.8). After inverse probability of treatment weighting and adjustment for treatment factors, there was no significant difference in overall survival across the surgical groups (adjusted hazard ratio [95% confidence interval]: 0.72 [0.23-2.28] for cystectomy versus bilateral salpingo-oophorectomy and 1.06 [0.53-2.15] for unilateral salpingo-oophorectomy versus bilateral salpingo-oophorectomy). Findings remained consistent when the analysis was stratified by age (18-39 and 40-49 years) and stage (IA and IC).

CONCLUSIONS

Among patients aged 18-49 with early-stage adult granulosa cell tumors, ovarian-preserving surgery (cystectomy or unilateral salpingo-oophorectomy) was associated with overall survival comparable to bilateral salpingo-oophorectomy. Further research comparing recurrence and disease-free survival across these surgical groups is needed to facilitate clinical decision-making.